Hypothalamic-hypophyseal dysfunction in children and adolescents after brain injury – a prospective observation

Česká verzia

Authors: D. Aleksijević ¹; V. Smolka ¹; E. Klásková ¹; V. Mihál ¹; J. Wiedermann ¹; P. Venháčová ¹; D. Krahulík ²; J. Zapletalová ¹
Authors place of work: Dětská klinika LF UP a FN, Olomouc přednosta prof. MUDr. V. Mihál, CSc. ¹; Neurochirurgická klinika LF UP a FN, Olomouc přednosta prof. MUDr. M. Houdek, CSc. ²
Published in the journal: Čes-slov Pediat 2012; 67 (4): 234-241.
Category: Original Papers

Summary

Introduction:
The neuroendocrine dysfunction following brain injury is described in 23–60% of adults and 15–21% of children in retrospective studies.

Aim of study:
To find out the prevalence of the hypothalamo-hypophyseal dysfunction in children after a brain injury and its dependence on the type of injury and the course of acute post-traumatic phase by prospective study during a twelve month period.

Patients and methods:
We evaluated growth, pubertal development and bone age in 58 patients (29 boys) after brain trauma. They underwent standard endocrine tests – TSH, fT4, IGF-1, PRL, morning cortisol, FSH, LH, testosterone (in boys), estradiol (in girls) in early post-traumatic period (2–14 days, T0) and in 3, 6 a 12 months after the injury (T3, T6 a T12). Dynamics tests were performed in patients with abnormalities in clinical examination and/or laboratory results. MRI was made in all patients in T12.

Results:
The median of age in time of an injury was 11.3 (0.5–18.7) years. Twenty three patients had GCS <8/15. In T0 diabetes insipidus (DI) occurred in 12 patients and a syndrome of inappropriate antidiuretic hormone (SIADH) in 4 patients. Hormonal changes simulated a central hypothyroidism (in 45% of patients) and a hypogonadotropic hypogonadism (in 25% of adolescents who were in time of injury in puberty ≥ Tanner 2). Combined pituitary hormones deficiency was found in 2 boys and DI in one patient in T3. In T6 hormonal dysfunctions were found in two boys (a precocious puberty and a growth hormone deficiency). In T12 a new endocrine dysfunction was diagnosed in five patients (two of them had a growth hormone deficiency, two had a hypogonadotropic hypogonadism and in one patient with a growth hormone deficiency a central hypothyroidism was confirmed). An empty sella has been found on MRI in two patients with a growth hormone deficiency. Patients with GCS ≤8/15 had hormonal dysfunction on T12 more often compared to those with a medium trauma and also DI or SIADH in acute posttraumatic period 11/23 vs. 4/35. The occurrence of early endocrine dysfunction significantly correlated with severity of injury (p≤0.05), but did not serve as a strong indicator of development of late hormonal dysfunction (p=0.5).

Conclusion:
Within a year from an injury hormonal disorder has occurred in 7 z 39 (17.9%) of patients. Neuroendocrine dysfunction as late a consequence of craniocerebral trauma is not as frequent in children as in adults. Risk factors influencing its development include severity of injury, abnormalities in the brain-imaging techniques and DI or SIADH in acute posttraumatic phase.

Key words:
traumatic brain injury, children, posttraumatic hormonal disorder, growth hormone deficiency, precocious puberty, risk factors

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